2020-07-07T22:06:13-05:00 2019-08-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2018-09-01 770191730 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA FOUNDATION COMM 5597244343 1560 E SHAW AVENUE FRESNO CA 93710 DEBORAH MOFFETT VP FINANCE 5597244343 2020-07-01 1 TRACY S PAGLIA P00366884 2099556100 2020-07-01 172.9.161.112 2020-07-01 13:16:32 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 2018 2020-11-06 18:47:13Z TIM JOSLIN 1560 E SHAW AVENUE FRESNO CA 93710 6722675 0 X WWW.COMMUNITYMEDICAL.ORG X 1986 CA IMPROVE THE HEALTH STATUS OF THE COMMUNITY AND PROMOTE MEDICAL EDUCATION. 15 12 18 16 0 0 15506856 6340750 534041 0 7144 0 -82632 181987 15965409 6522737 8108409 4661613 0 0 1921000 2270000 0 0 2713732 1479639 683395 11509048 7615008 4456361 -1092271 32403828 30621323 5876355 7327169 26527473 23294154 CHCC FOUNDATION'S MISSION IS TO SUPPORT COMMUNITY MEDICAL CENTERS' (CMC) OTHER AFFILIATED, NOT-FOR-PROFIT COMPANIES, THEREBY, IMPROVING THE HEALTH STATUS OF THE COMMUNITY AND PROMOTING MEDICAL EDUCATION. 0 0 4661613 4661613 0 THROUGH THE GENEROUS CONTRIBUTIONS OF THE COMMUNITY, THE ORGANIZATION FUNDED $4,661,613 OF FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER'S AND COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA'S MEDICAL AND OPERATING EQUIPMENT ACQUISITIONS, IT DEFRAYED $1,538,936 OF ITS PATIENT CARE OPERATING EXPENDITURES. 4661613 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 X 0 0 18 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 CA X DEBORAH MOFFET 5594596000 1560 E SHAW AVE FRESNO CA 93710 LINZIE DANIEL CHAIR 0.30 1.60 X X 0 0 0 FARID ASSEMI CHAIR-ELECT 0.30 1.60 X X 0 0 0 SUSAN ABUNDIS SECRETARY 0.30 1.60 X X 0 0 0 AJIT ARORA MD BOARD MEMBER 0.30 1.60 X 0 147100 0 KEITH BOONE MD AS OF 418 BOARD MEMBER 0.30 1.60 X 0 0 0 TERRANCE BRADLEY EDD BOARD MEMBER 0.30 1.60 X 0 0 0 JERRY COOK BOARD MEMBER 0.30 1.60 X 0 0 0 MANUEL CUNHA JR BOARD MEMBER 0.30 1.60 X 0 0 0 REN IMAI MD BOARD MEMBER 0.30 1.60 X 0 0 0 KAREN MCCAFFREY BOARD MEMBER 0.30 1.60 X 0 0 0 JOHN MCGREGOR BOARD MEMBER 0.30 1.60 X 0 0 0 VONG MOUANOUTOUA BOARD MEMBER (THRU 12/18) 0.30 1.60 X 0 0 0 RUTHIE QUINTO BOARD MEMBER 0.30 1.60 X 0 0 0 DAVID SLATER MD BOARD MEMBER 0.30 1.60 X 0 10000 0 ROGER STURDEVANT BOARD MEMBER 0.30 1.60 X 0 0 0 CHANDRASEKAR VENUGOPAL MD BOARD MEMBER 0.30 1.60 X 0 0 0 TIM JOSLIN PRESIDENT, CHIEF EXECUTIVE OFFICER 0.00 60.00 X 0 1021680 1295308 CRAIG CASTRO EVP, CHIEF OPERATING OFFICER 0.00 60.00 X 0 1260888 39260 JOSEPH NOWICKI SVP, CORPORATE CFO 0.00 60.00 X 0 934345 33578 KATHRYN ZENOVICH CEO - FOUNDATION/SVP CORP DEV 55.00 0.00 X 479571 0 34823 PATRICK RAFFERTY - FORMER EVP CHIEF OPERATIONS OFFICER THRU 08/18 0.00 0.00 X 0 2680081 358434 479571 6054094 1761403 1 1 1 0 0 20222 6320528 212619 6340750 381925 20222 199938 181987 181987 6522737 0 0 181987 4661613 4661613 541873 541873 1378171 1378171 38947 38947 187380 187380 123629 123629 67342 33671 33671 141481 141481 84822 42411 42411 7919 3959 3960 58674 8801 49873 21426 21426 1000 1000 40000 40000 DUES & SUBSCRIPTIONS 174354 87177 87177 MEALS 77093 77093 9284 1218 8066 7615008 4661613 239663 2713732 533 13 18445014 19237880 13868723 11338063 72465 31799 77390 63822 17093 13568 32403828 30621323 244918 240161 5631437 7087008 5876355 7327169 X -3411957 -6370202 29555837 29280763 383593 383593 26527473 23294154 32403828 30621323 X -1092271 -2141048 X 0 1 X 1 0 X 10861549 12269678 3560504 14615080 4226635 45533446 10861549 12269678 3560504 14615080 4226635 45533446 18545219 26988227 646538 1771798 2031339 1139730 0 5589405 135147 135147 51257998 3598766 0.52650 0.55770 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: ESCROW AND REFUNDS - 2017 AMOUNT: $ 135,147. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 383593 383593 383593 383593 383593 383593 383593 383593 383593 383593 0.00000 1.00000 0.00000 0 0 77390 63822 13568 13568 PAYABLE TO AFFILIATES 7087008 7087008 PART V, LINE 4: THE ENDOWMENT REPORTED IN PART V IS A PERMANENT ENDOWMENT TO PROVIDE A PERMANENT SOURCE OF INCOME TO SUPPORT PATIENT CARE. FORM 990, SCHEDULE D, PART X, LINE 2: THERE IS NO FOOTNOTE FOR FIN 48 IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DUE TO IMMATERIALITY. WHSN 2019 402147 20222 381925 75031 82808 4960 37139 402147 20222 381925 75031 82808 4960 37139 199938 181987 1 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 1560 E SHAW AVENUE FRESNO CA 93710 941156276 501(C)(3) 4383267 OPERATING EXPENSES COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1560 E SHAW AVENUE FRESNO CA 93710 942864615 501(C)(3) 278346 OPERATING EXPENSES 2 0 PART I, LINE 2: CHCC FOUNDATION IS GOVERNED BY A BOARD OF TRUSTEES THAT SETS POLICY AND IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF GRANTS. X 1 1 0 1 0 0 0 0 0 0 0 TIM JOSLIN PRESIDENT, CHIEF EXECUTIVE OFFICER 0 893890 0 0 0 127790 0 1284124 0 11184 0 2316988 0 0 CRAIG CASTRO EVP, CHIEF OPERATING OFFICER 0 793081 0 329530 0 138277 0 19250 0 20010 0 1300148 0 65524 JOSEPH NOWICKI SVP, CORPORATE CFO 0 592513 0 220182 0 121650 0 16500 0 17078 0 967923 0 63383 KATHRYN ZENOVICH CEO - FOUNDATION/SVP CORP DEV 330352 0 127422 0 21797 0 15882 0 18941 0 514394 0 0 0 PATRICK RAFFERTY - FORMER EVP CHIEF OPERATIONS OFFICER THRU 08/18 0 479458 0 253182 0 1947441 0 350471 0 7963 0 3038515 0 1838576 PART I, LINE 1A THE CORPORATION PAYS SOCIAL CLUB DUES FOR KATHRYN ZENOVICH, FOUNDATION CEO. SHE IS A FUND RAISER AND OFTEN ATTENDS THE CLUB FOR WORK-RELATED DUTIES. THE EXPENSE IS TREATED AS TAXABLE COMPENSATION AND REPORTED ON HER W-2. PART I, LINE 4B LINE 4B: DURING THE YEAR, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, MADE THE FOLLOWING CONTRIBUTIONS TO THE PLAN FOR THE FOLLOWING INDIVIDUALS: - TIM JOSLIN $1,267,624 - PATRICK RAFFERTY $333,971 LINE 4B: DURING THE YEAR, COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA, A RELATED ORGANIZATION, MADE THE FOLLOWING DISTRIBUTIONS FROM THE PLAN FOR THE FOLLOWING INDIVIDUALS: - CRAIG CASTRO $65,524 - JOSEPH NOWICKI $63,383 - PATRICK RAFFERTY $1,838,576 PART I, LINE 3: THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE OF THE METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. X 59072 FMV X 2 33207 FMV X 105 120340 FMV 0 0 1 0 PART I, COLUMN (B): THE ORGANIZATON IS REPORTING IN PART I, COLUMN(B) THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART V, LINES 1 & 2: CHCC IS THE COMMON PAYMASTER FOR ITSELF, THE FOUNDATION, AND FCH&MC. FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA (CHCC) IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A CHCC IS THE SOLE MEMBER OF CHCCF. IT HAS THE SOLE AND EXCLUSIVE RIGHT TO ELECT ALL OF THE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CHCC IS THE SOLE MEMBER OF THIS ENTITY. AS SUCH, IT HAS THE RIGHTS OF MEMBERS CONFERRED BY CHAPTER 3 OF THE NONPROFIT PUBLIC BENEFIT CORPORATION LAW, SECTIONS 5310 - 5354, WHICH INCLUDES THE RIGHTS TO APPROVE AMENDMENTS TO THE ARTICLES, BYLAWS AND SALE OF ASSETS OUTSIDE THE NORMAL COURSE OF BUSINESS. THE MOST RECENT AMENDED ARTICLES OF INCORPORATION PROVIDES THAT UPON DISSOLUTION ALL REMAINING ASSETS WILL BE DISTRIBUTED TO CHCC OR ITS SUCCESSORS. FORM 990, PART VI, SECTION B, LINE 11B UPON COMPLETION OF AN INITIAL REVIEW BY SENIOR MANAGEMENT, THE FORM IS REVIEWED AT A MEETING OF THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. THE FINALIZED FORM 990 THEN BECOMES A RECORD OF THE ORGANIZATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF COMMITTEE WITH BOARD DELEGATED POWERS SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER COMMITTEE WITH BOARD DELEGATED POWERS ALSO COMPLETES A CONFLICT OF INTEREST DISCLOSURE STATEMENT PRIOR TO THE ASSIGNMENT OF THEIR DUTIES AND THEREAFTER ON AN ANNUAL BASIS. THE STATEMENT ASKS SPECIFIC QUESTIONS THAT WOULD DETERMINE IF THERE ARE CONFLICTS OF INTERESTS. CMC'S CHIEF AUDITOR, ETHICS & COMPLIANCE OFFICER AND CHIEF LEGAL OFFICER REVIEW THE RESPONSES AND DETERMINE WHETHER THERE IS A CONFLICT BASED ON POLICY. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE DIRECTOR, PRINCIPAL OFFICER, OR MEMBER COMMITTEE WITH BOARD DELEGATED POWERS WILL BE REMOVED FROM DECISION MAKING AS IT PERTAINS TO THAT CONFLICT. TO ENSURE THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, PERIODIC REVIEWS ARE CONDUCTED. THE PERIODIC REVIEWS, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: 1) WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S-LENGTH BARGAINING; 2) WHETHER ACQUISITIONS OF PHYSICIAN PRACTICES AND OTHER PROVIDER SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT; 3) WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ARRANGEMENTS WITH MANAGEMENT SERVICE ORGANIZATIONS AND PHYSICIAN HOSPITAL ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT; AND 4) WHETHER AGREEMENTS TO PROVIDE HEALTH CARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES, AND THIRD PARTY PAYORS FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. FORM 990, PART VI, SECTION B, LINE 15A RESPONSIBILITY FOR OVERSIGHT OF EXECUTIVE COMPENSATION RESTS WITH THE BOARD'S EXECUTIVE COMPENSATION SUBCOMMITTEE. THE COMMITTEE WILL "CONSIDER ALL MATTERS INVOLVING COMPENSATION AND BENEFITS OF (I) CORPORATE OFFICERS WHO ARE CLASSIFIED AS & "DISQUALIFIED PERSONS" PURSUANT TO INTERNAL REVENUE CODE SECTION 4958; (II) ALL OTHER CORPORATE OFFICERS WHO ARE SENIOR VICE PRESIDENTS AND EXECUTIVE VICE PRESIDENTS AND (III) THE PRESIDENT/CHIEF EXECUTIVE OFFICER." THROUGH THE EXECUTIVE COMPENSATION SUBCOMMITTEE, THE BOARD HAS ENGAGED SULLIVAN, COTTER AND ASSOCIATES, INC. TO CONDUCT A TOTAL COMPENSATION REVIEW FOR THOSE INDIVIDUALS IDENTIFIED IN THEIR SCOPE OF RESPONSIBILITY. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: UNCOLLECTIBLE PLEDGES FROM PRIOR YEARS -26,933. NPV ADJUSTMENT FOR UNCOLLECTIBLE PLEDGES -2,114,115. COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1560 E SHAW AVENUE FRESNO CA 93710 942864615 SUPPORTING ORG CA 501(C)(3) LINE 12B, II N/A 0 FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER 1560 E SHAW AVENUE FRESNO CA 93710 941156276 HOSPITAL CA 501(C)(3) LINE 3 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1 SIERRA HOSPITAL FOUNDATION PO BOX 1232 FRESNO CA 93715 941431181 INACTIVE CA 501(C)(3) LINE 3 COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1 SANTE HEALTH FOUNDATION 7370 N PALM AVENUE SUITE 101 FRESNO CA 93711 200517238 HEALTHCARE CA 501(C)(3) LINE 7 N/A 0 AMI REALTY PARTNERS LP 1867 E FIR SUITE 104 FRESNO CA 93720 203709876 REAL PROPERTY RENTAL CA N/A CALIFORNIA IMAGING INSTITUTE LLC 1867 E FIR SUITE 104 FRESNO CA 93720 203766736 IMAGING SERVICES CA N/A COMMUNITY HEALTH ENTERPRISES INC 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 770175659 PHARMACY SALES CA N/A C 0 COMMUNITY HEALTH CARE PLAN INC 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 770246798 HEALTH CARE PLAN CA N/A C 0 COMMUNITY INSURANCE SERVICES COMPANY 789 N MEDICAL CENTER DRIVE EAST CLOVIS CA 93611 980674776 INSURANCE CJ N/A C 0 SANTE HEALTH SERVICES INC 6051 N FRESNO STREET FRESNO CA 93710 200382364 INACTIVE CA N/A C 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 1 FRESNO COMMUNITY HOSPITAL & MEDICAL CENTER B 4383267 CASH COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA B 278346 CASH